Noninvasive Diagnosis Of Nonalcoholic Steatohepatitis And Fibrosis

Objective: To explore the clinical noninvasive evaluation value of non-alcoholic fatty liver disease fibrosis score(NFS),fibrosis 4 score(FIB-4),hypersensitive c-reactive protein(HsCRP)in non-alcoholic steatohepatitis(NASH)and liver fibrosis by analyzing the diagnostic value of these techniques used alone or in combination in non-alcoholic steatohepatitis(NASH)and liver fibrosis.Methods: This is a collection include the data of 57 patients who had been performed liver biopsy and diagnosed as nonalcoholic fatty liver disease(NAFLD)by liver pathology between June 2011 to October 2018 at Sichuan Provincial People's Hospital.Firstly,according to the liver pathological SAF grading,the patients were divided into simple fatty liver(NAFL)(n=12)and nonalcoholic fatty liver(NASH)(n=45).Secondly,the NASH patients were divided into F1 fibrosis(n=16),F2 fibrosis(n=22)and F3 fibrosis(n=7).Clinical and laboratory indexes were determined respectively.The NAFLD non-alcoholic liver fibrosis score(NFS)and fib-4 index(FIB-4)were calculated.SPSS21.0 software was used for statistical analysis of the experimental data.Logistic regression was used to calculate the diagnostic indicators of each variable.Results:(1)There was statistical difference in HsCRP(F :2.23,P :0.024)between NAFL group and NASH group,while there was no statistical difference in NFS and FIB4(P >0.05).(2)There were statistically significant differences in uric acid,insulin and fasting glucose between NAFL group and NASH group(F : 2.25,3.85 and 2.23,respectively.P:0.028,0.000 and 0.026,respectively).(3)By comparing the NAFL group and NASH group combined model,it was found that FIB4 combined with HsCRP,NFS combined with HsCRP,and in the combination of FIB4,NFS and HsCRP had statistically significant(P0.0008,0.0008,0.0007),and their area under the curve(AUC)separately was 0.857,0.844 and 0.846.(4)There were statistically significant differences between the F1-2 fibrosis and the F3 fibrosis group in NFS,HsCRP and uric acid(F separately was 2.18,2.05 and 2.12,P separately was 0.035,0.047 and 0.040).NFS combined with HsCRP showed a statisticaldifference(P : 0.0393),with an AUC of 0.741.Their sensitivity and specificity were 86%,61%,and positive and negative predictive values were 29% and 96%.NFS combined with HsCRP had higher sensitivity and negative predictive value,indicating that it had some efficacy in excluding advanced fibrosis stage F3.Conclusion:(1)HsCRP,HsCRP combined with NFS,HsCRP combined with fib-4,or the three combined have certain diagnostic efficacy in the diagnosis of non-alcoholic steatohepatitis.(2)NFS combined with HsCRP has a certain value in excluding advanced fibrosis and reducing liver biopsy in non-alcoholic steatohepatitis.